We present three case reports of male patients presenting with rapidly progressive dementia the year after Hurricane Maria within a four-month period.
Case 1: 67 y/o male presented with memory difficulty and behavioral changes.Upon examination, patient was oriented only in place and person. Brain MRI showed gyriform multifocal signal abnormality and restricted diffusion involving bilateral cerebral hemispheres and subtle abnormality in medial thalami. Lumbar puncture was performed and 14-3-3 protein was detected in the cerebrospinal fluid. Patient died six weeks after evaluation.
Case 2: 82 y/o male presented with progressive mental status deterioration, marked dysarthria and postural tremor. Brain MRI findings consistent with large areas of hyperintensities in the cortical region of both occipital, temporal and left parietal and frontal lobes. Lumbar puncture was performed but 14-3-3 protein was not detected in the cerebrospinal fluid. Patient died four months after evaluation.
Case 3: 77 y/o male presented with functional decline. Examination was pertinent for hyperreflexia bilaterally with sustained clonus. Brain MRI showed hyperintensities at cortex. Lumbar puncture was performed but 14-3-3 protein was not detected in the cerebrospinal fluid. Patient died two weeks after evaluation and autopsy was performed that showed abnormal prion protein by Western blot.